Follow-up of blood test results (14HDC00894)

A man was enrolled in an ongoing clinical trial. Regular blood
tests were taken as part of the trial, and the trial clinicians
undertook to notify participants' general practitioners (GP) of any
significantly abnormal findings.

The man consulted his GP and had routine screening blood tests,
which showed a slightly low haemoglobin level. About a year later,
blood tests were ordered as part of the trial which showed a low
haemoglobin level. A trial clinician sent the man's GP a letter
with a copy of the man's blood results. Neither the letter nor the
results are in the clinical record. The man took a copy of the
letter to a subsequent appointment with the GP, and the GP recorded
that the man had mild anaemia. The GP prescribed the man iron
supplements.

The first of two further blood test results ordered six months
later by the trial clinicians showed that the man had a low
haemoglobin level; the second test showed he had a haemoglobin
level within the normal range. The GP told HDC that the first set
of results did not confirm iron deficiency, and that he did not
receive the second set of results.

The GP ordered further blood tests approximately eight months
later which showed a haemoglobin level below the normal range and
low ferritin. The GP informed the man that he was mildly anaemic
and prescribed further iron supplements.

The man transferred to another GP fourteen months later (having
not seen a GP during that period), who referred him for blood tests
which revealed a significantly low haemoglobin level. Nine weeks
later, the GP asked the man to return for a follow-up appointment
and then referred him for a colonography and a gastroscopy which
revealed a malignant tumour in the man's stomach. While awaiting a
laparoscopy, the man developed neurocognitive symptoms and brain
metastases and later died.

It was held that by not determining the possible underlying
cause of the man's anaemia, failing to organise structured
follow-up, and not discussing the blood test results with the man,
the first GP failed to provide services to the man with reasonable
care and skill and breached Right 4(1).

Adverse comment was made about the first GP in relation to his
documentation and management of test results, and about the lack of
such policy at his GP practice.

It was held that because the second GP did not follow up on the
man's abnormal haemoglobin level for nine weeks, he failed to
provide services to the man with reasonable care and skill and
breached Right 4(1).

Adverse comment was made about the lack of a policy for the
management of test results at the second GP's practice.